Patient monitor including multi-parameter graphical display

ABSTRACT

A patient monitoring system and method are disclosed which provide a caregiver with more easily identifiable indications of the state of multiple physiological parameters in order to give the caregiver an indication of the patient&#39;s overall wellness in an efficient manner. Multiple physiological parameter sets are plotted on a graph, along with an indication of each parameter set&#39;s normal range. An overlapping area for all set&#39;s normal ranges provides an indication of an ideal patient state. In an embodiment, alerts are generated based on parameters distance from normal readings.

PRIORITY CLAIM

This application is a continuation of U.S. patent application Ser. No.14/566,032, filed Dec. 10, 2014, titled Patient Monitor IncludingMulti-Parameter Graphical Display, which is a divisional of U.S. patentapplication Ser. No. 12/559,815, filed Sep. 15, 2009, pending, titledPatient Monitor Including Multi-Parameter Graphical Display, whichclaims priority to prior U.S. Provisional Patent Application No.61/097,185, filed Sep. 15, 2008, titled Patient Monitor IncludingMulti-Parameter Graphical Display, and incorporated by reference herein.

FIELD OF THE INVENTION

The present disclosure relates to the field of patient monitors. Morespecifically, the disclosure relates to processing and displayingmultiple parameters to quickly determine an indication of patientwellness.

BACKGROUND

In order to assess patient condition, caregivers often desire knowledgeof multiple physiological parameters of the patient. These physiologicalparameters include, for example, oxygen saturation (SpO2), hemoglobin(Hb), blood pressure (BP), pulse rate (PR), perfusion index (PI), andPleth Variable Index (PVI), among others. This monitoring is importantto a wide range of medical applications. Oximetry is one of thetechniques that has developed to accomplish the monitoring of some ofthese physiological characteristics. It was developed to study and tomeasure, among other things, the oxygen status of blood. Pulseoximetry—a noninvasive, widely accepted form of oximetry—relies on asensor attached externally to a patient to output signals indicative ofvarious physiological parameters, such as a patient's constituents oranalytes, including, for example, those listed above as well as apercent value for carbon monoxide saturation (HbCO), methemoglobinsaturation (HbMet), fractional saturations, total hematocrit,billirubins, or the like. As such a pulse oximeter is one of a varietyof patient monitors that help provide monitoring of a patient'sphysiological characteristics.

A pulse oximeter sensor generally includes one or more energy emissiondevices, such as specific wavelength emitting LEDs, and one or moreenergy detection devices. The sensor is generally attached to ameasurement site such as a patient's finger, toe, ear, ankle, or thelike. An attachment mechanism positions the emitters and detectorproximal to the measurement site such that the emitters project energyinto the tissue, blood vessels, and capillaries of the measurement site,which in turn attenuate the energy. The detector then detects thatattenuated energy. The detector communicates at least one signalindicative of the detected attenuated energy to a signal processingdevice such as an oximeter, generally through cabling attaching thesensor to the oximeter. The oximeter generally calculates, among otherthings, one or more physiological parameters of the measurement site.

Pulse oximeters are available from Masimo Corporation (“Masimo”) ofIrvine, Calif. Moreover, some exemplary portable and other oximeters aredisclosed in at least U.S. Pat. Nos. 6,770,028, 6,658,276, 6,157,850,6,002,952, and 5,769,785, which are owned by Masimo, and areincorporated by reference herein. Such oximeters have gained rapidacceptance in a wide variety of medical applications, including surgicalwards, intensive care and neonatal units, general wards, home care,physical training, and virtually all types of monitoring scenarios.

Typically, the physiological parameters are displayed to the caregiveras separate numbers on a patient monitor. Although this provides a largeamount of data in a relatively small space, the greater the number ofparameters being monitored, the more confusing and cluttered a displaycan become.

SUMMARY

A patient monitor including graphical display of combined physiologicalparameters provides a more powerful overall wellness assessment toolthan when any physiological parameter is used by itself. A caregiver canmore quickly and accurately determine if a patient is within normalparameters and which, if any, parameters may indicate a problem for thepatient.

One aspect of the disclosure provides a patient monitor that candetermine a range of normal, healthy parameters for a given patient andthat has a display capable of providing a geometric representation ofthis range graphically for one or more parameters. The patient monitorcan then represent whether a patient's current condition for these oneor more parameters is within the normal range. In an aspect of thisdisclosure, the graphical presentation displays overlaying ranges formultiple parameters and provides an easy-to-understand representation ofwhether or not a patient is within acceptable ranges for all of themonitored parameters at once.

Another aspect of this disclosure provides that each parameter orparameter set receives a color code or codes that can be displayed whenone parameter or parameter set is not within a normal range, therebyproviding readily identifiable feedback to a caregiver of whichmonitored parameter may be a problem for the patient. Additionally,various alerts may be triggered by the monitor when one or moreparameter or parameter set falls outside the normal range, includingvisual and/or audible alerts.

The patient parameters discussed herein also can be measured by a singledevice or by multiple devices that are fed into one or more patientmonitoring devices in various embodiments.

In one embodiment of the present disclosure, a method for providing anindication of a patient's condition includes: noninvasively measuring aplurality of physiological parameters using a light attenuation bypulsing blood; loading a wellness range for each of two or more of theplurality of physiological parameters; displaying an area of a graphdefining a normal range for the intersection of the wellness ranges oftwo of the plurality of physiological parameters; and plotting on thegraph a point of intersection between the two physiological parametersrepresenting a current measurement. The method can further includeproviding an indication that the graphed point of intersection isoutside the defined normal range area, based on one or both of thegraphical parameters.

In another embodiment, a method for providing an indication of apatient's condition, includes: measuring a plurality of physiologicalparameters; defining a first area of a graph constituting a normal rangefor the intersection of a first set of two of the plurality ofphysiological parameters; graphing a first point of intersection betweenthe first set of two physiological parameters; defining a second area ofthe graph constituting a normal range for an intersection of a secondset of two of the plurality of physiological parameters, wherein thesecond set includes at least one physiological parameter distinct fromthe first set; defining an intersection area of the first area and thesecond area; graphing a second point of intersection between the secondset of two physiological parameters; and providing an indication of astate of wellness of the patient based on the first point's relation tothe intersection area and second point's relation to the intersectionarea. The method can also indicate a state of alert when one or both ofthe first point and second point fall outside the intersection area.This state of alert may include an audible alert, a colored displayindication, or the like.

In an embodiment, defining the second area of the graph can includenormalizing the second area to increase the intersection area with thefirst area. In an embodiment, the first area of the graph uses datapoints from the physiological parameters that were gathered when thepatient was known to be well. The first area may be defined by using abest fit curve analysis, may include or disregard one or more outlierpoints, or the like. In an embodiment, the method can further includethe step of making visual representations of the first area, secondarea, and intersection area on a display.

In yet another embodiment of the disclosure, a system for providing anindication of a patient's condition includes: a patient monitor; asensor for providing the patient monitor with indications of a pluralityof physiological parameters; a signal processing module configured todetermine values for the physiological parameters from the indications;a graphing module configured to define two or more areas of a graph,each comprising a normal range for the intersection of a set of two ormore of the plurality of physiological parameters, the graphing modulefurther configured to define an intersection area of the two or moreareas; and a display configured to display a graph including theintersection area and the plurality of areas. The system can alsoinclude an alert module, capable of indicating whether a set of currentsensor readings is within the intersection area of the graph. The alertmodule can include more than one alert level, such as to indicatevarious degrees of concern.

In an embodiment, the system includes a speaker, wherein the alertmodule sounds an alarm through the speaker if the set of current sensorreadings are not within the intersection area. In yet another embodimentthe patient status system includes a memory unit storing data read bythe graphing module to define the area of the graph comprising thenormal range for the intersection of the set of two of the plurality ofphysiological parameters. The memory unit stores data particular to thepatient being monitored, in an embodiment, and can be removable—such asflash memory. In another embodiment, data stored on the memory unitinclude empirical data gathered from a plurality of individuals selectedfrom a population.

In an embodiment, the patient status system further includes acommunication module capable of connecting to a database and receivingdata stored thereon for the graphing module to define the area of thegraph comprising the normal range for the intersection of the set of twoof the plurality of physiological parameters.

In yet another embodiment, a method for providing an individual baselinefor a patient's wellness, includes the steps of: measuring a pluralityof physiological parameters of the patient over a period of time, usinga non-invasive sensor; identifying a plurality of graph points for theintersection of at least two of the physiological parameters, each graphpoint indicative of the at least two physiological parameters measuredat approximately the same time; defining an area of a graph constitutinga normal range from the plurality of graph points; and storing for laterretrieval at least one of: (1) the plurality of physiological parametermeasurements over time, (2) the plurality of graph points, or (3) thearea of a graph constituting the normal range from the plurality ofgraph points. The method for providing an individual baseline for apatient's wellness is undertaken when the patient is healthy in someembodiments. The method for providing an individual baseline for apatient's wellness also includes loading the stored data and comparingthe stored data to at least one new measurement of physiologicalparameters of the patient, in an embodiment, which may be done at a timewhen the patient's status is unknown.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings and the associated descriptions are provided toillustrate embodiments of the present disclosure and do not limit thescope of the claims. Corresponding numerals indicate correspondingparts, and the leading digit of each numbered item indicates the firstfigure in which an item is found.

FIG. 1 illustrates a perspective view of an embodiment of a patientmonitor system according to the disclosure.

FIG. 2 illustrates a block drawing of a patient monitor system accordingto the disclosure.

FIG. 3 illustrates an example graph that may calculated by the patientmonitor system 100 of FIG. 1.

FIGS. 4-6 illustrate various examples of physiological parameter-setgraphs.

FIG. 7 illustrates an overlapping graph of FIGS. 4-6.

FIG. 8 illustrates the overlapping graph of FIG. 7 highlighting the areacommon to all three parameter-set boundaries.

FIG. 9 illustrates an example display including both separate andcombined parameter graphs.

FIG. 10 is a block diagram of an embodiment of a method for indicating apatient's condition.

FIG. 11 is a block diagram of an embodiment of a method for determininga patient's healthy vital sign ranges.

FIG. 12 is a block diagram of an embodiment of a method for comparing apatient's condition to pre-recorded healthy patterns.

DETAILED DESCRIPTION

Aspects of the disclosure will now be set forth in detail with respectto the figures and various embodiments. One of skill in the art willappreciate, however, that other embodiments and configurations of thedevices and methods disclosed herein will still fall within the scope ofthis disclosure even if not described in the detail of some otherembodiments. Aspects of various embodiments discussed do not limit thescope of the disclosure herein, which is instead defined by the claimsfollowing this description.

Turning to FIG. 1, an embodiment of a multi-parameter patient monitorsystem 100 is illustrated. The patient monitor system 100 includes apatient monitor 102 attached to a sensor 106 by a cable 104. The sensormonitors various physiological data of a patient and sends signalsindicative of the parameters to the patient monitor 102 for processing.The patient monitor includes a display 108 that is capable of displayingreadings of various monitored patient parameters, including one or moregraphs 110. Display 108 may be a liquid crystal display (LCD), a cathoderay tube (CRT), a plasma screen, a Light Emitting Diode (LED) screen,Organic Light Emitting Diode (OLED) screen, or any other suitabledisplay. A patient monitor system 102 may monitor oxygen saturation(SpO2), perfusion index (PI), pulse rate (PR), hemoglobin count, andother parameters. Typically, a patient monitor 102 will also includesome sort of control interfaces 112 and a speaker 114 for audiblealerts. Embodiments of a patient monitor 102 can also include inputsfrom other devices, such as, an EKG machine, an ECG machine, arespirator, a ventilator, a blood pressure monitor, a capnograph,combinations of the same, or the like.

FIG. 2 illustrates details of a patient monitor system 100 in aschematic form. Typically a sensor 106 includes energy emitters 216located on one side of a patient monitoring site 218 and one or moredetectors 220 located generally opposite. The patient monitoring site218 is usually a patient's finger (as pictured), toe, ear lobe, or thelike. Energy emitters 216, such as LEDs, emit particular wavelengths ofenergy through the flesh of a patient at the monitoring site 218, whichattenuates the energy. The detector(s) 220 then detect the attenuatedenergy and send representative signals to the patient monitor 102.

Specifically, an embodiment of the patient monitor 102 includesprocessing board 222 and a host instrument 223. The processing board 222includes a sensor interface 224, a digital signal processor (DSP) 226,and an instrument manager 228. The host instrument typically includesone or more displays 108, control interfaces 112, and a speaker 114 foraudio messages (including alerts, tones, or verbal indicators). Controlinterfaces 112 may comprise buttons, a keypad, a full keyboard, a trackwheel, and the like. Additionally embodiments of a patient monitor 102can include buttons implemented in software and actuated by a mouse,trackball, touch screen, or other input device. The host instrument 223may optionally include memory 113 and/or a wired or wireless networkconnection 115. Memory 113 can be used to buffer and/or store forextended periods host instrument 223 software, sensor readings, and thelike. Additionally a network connection 115 may allow the hostinstrument 223 to communicate with other patient monitors, remotecomputers or displays, servers, and the like.

The signals from the sensor 106 detector(s) 220 are received by thesensor interface 224 and passed to the DSP 226 for processing intorepresentations of physiological parameters. The sensor interface 224may additionally perform analog and/or digital signal conditioning.These are then passed to the instrument manager 228, which may furtherprocess the parameters for display by the host instrument 223. In someembodiments, the DSP 226 also communicates with a memory 230 located onthe sensor 106; it typically contains information related to theproperties of the sensor that may be useful in processing the signals,such as, for example, emitter 216 energy wavelengths. Host instrument223 then displays one or more of these physiological parametersaccording to instructions from the instrument manager 228. In anembodiment, the instrument manager includes a graph generation modulethat allows various parameters to be displayed by the host instrument223 in graphical form.

One example parameter that may be graphed in this manner is theperfusion index (PI), which, in an embodiment of the disclosure, mayinclude a ratio of the pulsatile blood flow to the nonpulsatile orstatic blood in peripheral tissue. Generally, PI is a measure ofperipheral perfusion that can be continuously and noninvasively obtainedfrom a pulse oximeter. Another exemplary parameter is the PlethysmographVariable Index (PVI) developed by Masimo Corporation, Irvine, Calif. Inan embodiment, PVI includes a measure of the dynamic changes in theperfusion index (PI) that occur during a respiratory cycle. Theseparameters can be graphed against others, such as pulse rate (PR), andplotted in two-dimensional space. Similarly, these and other parameterscan be used and plotted in two-, three-, or more-dimensional space onthe display 108.

FIGS. 3-8 illustrate exemplary graphs providing disclosure of specificexamples of the more general concept of multiple parameterssimultaneously and graphically incorporated into a measurement andrepresented on display 108 of the patient monitor 102 of FIGS. 1 and 2.As shown in FIG. 3, the patient monitor 102 can display a graph plottingtwo physiological parameters, such as perfusion index (PI) and pulserate (PR), versus one another. The display 108 represents a graph 110that indicates the intersection of the respective values of PI and PR ata point in time by displaying point 340, for example. A plurality ofpoints 342 are displayed for the intersection value of PI and PR forother points in time. The intervals between the appearances of thedisplay points on the screen can be varied. For example, a display point340 can be shown for readings taken every 5 seconds. A display point 340can include a direct reading of one or more patient parameters,statistically combined measurements, corrected measurements, or thelike. Further, the plurality of points 342 may show readings over agiven period of time, for example, 1 hour. One or more points 340, 342may be displayed at any given time. Displaying multiple points 342 mayhelp provide trending data, while a single point 340 may provide themost recent measurement. In an embodiment displaying multiple points ondisplay 108, the more recent point(s) may be displayed in a differentcolor(s), a different shape(s), flashing, or by using some otherdistinguishing characteristic(s) to help differentiate it or them fromprevious data points.

Other combinations of physiological parameters to be displayed arepossible, for example, blood pressure (BP) and perfusion index (PI)(BP/PI), blood pressure (BP) and Pleth Variable Index (PVI) (BP/PVI),Pleth Variable Index (PVI) and hemoglobin (HB) (PVI/HB), and respiratoryrate (RR) and oxygen saturation (SpO2). Generally, hemodynamicparameters can be compared with respiratory rate (RR) or respiratoryvolume (RV). Further, one of skill in the art will recognize othercommon parameters that may be graphed against each other to providehelpful information to a caregiver.

Referring to FIG. 4, when a plurality of points 342 are measured—whetherdisplayed or not—for a combination of parameters, in this case PI andPR, the scatter pattern may eventually form a cluster shape 444. As theplurality of points 342 increases, the shape 444 will generally becomemore defined, and an indication of the shape 444 can also be illustratedon the graph 110. The shape 444 is defined by connecting the outermostpoints, statistically relevant points, or the like 342, in anembodiment. In another embodiment, processing may discount one or morepoints 340 that are determined to be outliers 445. Similarly best fitcurve processing may be used to define the shape. In an embodiment,displaying the shape 444, rather than multiple points 342, may bepreferable to help avoid cluttering the graph and/or confusion with themost current reading's plotted point. In this way, a caregiver canquickly determine if the current point is within the general trending(which likely indicates a normal or at least stable condition) oroutside the general trending (which may indicate a condition ofconcern). Similarly, movement of a current plot point away from ortowards the shape 444 may indicate a degrading or improving condition,respectively.

In one use of an embodiment, when a patient is healthy or feelingnormal, testing can be performed on the patient to determinepatient-specific shapes 444 or at least patient-specific calibrations ornormalizations of broader multi-patient shapes for combinations ofvarious physiological parameters. Representations of these shapes 444can then be stored with a patient record for later use. In anembodiment, the shape 444 data is stored within the patient monitor 102.In another embodiment, the data representing the shape 444 can betransferred or transmitted to another device through any of a variety ofcommunications methods. For example, patient monitor 102 may include awired or wireless connection to a network, such as a LAN, WAN, theInternet, or the like. Data representing the shape 444 for a patient maythen be transferred to a centralized database, such as with a patient'smaster health records or a special purpose database for patient monitorparameters. In another embodiment, the data may be transferred to atransportable memory device, such as, for example, a disk, a CD, a DVD,a flash memory drive, a USB drive, or other memory device. This devicecan be provided to a patient for ready transfer among hospitals, carefacilities, physician's offices, and the like. The devices can also bemaintained with the patient's records for future visits. In anembodiment, for example, once a patient has been monitored while healthyfor some period of time, the sensor 106 may be removed from the sensorinterface 224 and a memory unit may be connected to this same port. Thedata in raw form of a set of data points 342 or in a processedrepresentation of the shape 444 can be downloaded to the memory unit. Itis understood that in other embodiments, the patient monitor 102 mayhave a separate port or drive for removable memory and/or similarly maytransfer the data to a server, a database, or a computer through wiredor wireless networks.

In another embodiment, a patient monitor 102 can utilize a generic shape444 that was developed from experimental data of some number of healthyindividuals. In yet another embodiment, a patient monitor 102 can beginutilizing a generic shape 444 based on empirical data and adjust theshape 444 based on the plurality of points 342 measured by monitoringthe patient over time. One of skill in the art will understand thatvarious combinations of these and similar techniques can be used fordifferent embodiments, different sets of parameters within a singleembodiment, and the like.

In an embodiment, when a patient returns for possible health reasons,the data representing the shape 444 can then be loaded into the patientmonitor 102, and the patient's current readings from a patient monitor102 can be displayed as within or external to the shape 444, indicatingthat the patient is within his or her normal range, borderline,abnormal, or the like. For example, if the patient's records include aflash drive that was loaded with the data representing the shape 444,the drive may first be connected to the patient monitor 102 (as atsensor interface 224 as described above), the data can be loaded, thedrive removed, and finally the sensor 106 connected to the sensorinterface 224 to enable patient monitoring.

In an embodiment, the patient monitor 102, through the DSP 226, theinstrument manager 228, or another module—such as a particular graphicalprocessing module, can calculate current readings and their distancefrom the shape 444, which may help provide an indication of the severityof a patient's condition. For example, a patient whose PI v. PR readingsfall well outside the shape 444 are likely in a worse condition thanthose that only fall outside the shape 444 by a small amount.Additionally, trending data may be processed. For example, the greaterthe time that updated readings are outside the normal range, the moresevere a patient's condition is likely to be. Similarly, if dataindicates that parameter readings are moving away from the normal range(and thus shape 444), a patient's condition may be worsening.

FIGS. 5 and 6 illustrate other potential parameter combination exampleshaving other shapes 548 and 652, as defined by sets of points 546 and650, respectively. FIG. 5 represents a hypothetical shape for BP versusPI; FIG. 6 illustrates a hypothetical shape for BP versus PVI. Theactual shapes 548 and 652 may be quite different, but the conceptsdiscussed are equally applicable. These shapes 444, 548, and 652 can beconsidered “normal” for the patient and establish a wellness baselinefor each particular combination of physiological parameters, whenreadings are taken while a patient is in good health. In an embodiment,these shapes 444, 548, 652 can be combined in a single graphical display(as pictured in FIG. 7). The shapes can be variously distinguished bydifferent colors or different line or fill patterns to indicate thevarious combinations of elements. Additionally, as shown in FIG. 8, thecombined graphs form a new shape 854 from their intersection. Theintersection shape 854 defines an area where all the combinations ofphysiological parameters are normal for the patient and establish acombined wellness baseline. A caregiver finding all parameters withinthis shape can be quickly apprised that the patient is in a normalcondition.

When combining these graphs to obtain an intersection shape 854, thedigital signal processor 226, the instrument manager 228, or anotherprocessing unit of the patient monitor 102 may scale, shift, orotherwise normalize one or more of the various graphs to increase ormaximize the overlapping areas of the multiple graphs. This wouldadvantageously provide a greater intersection shape 854, and in turn agreater indication for caregivers of general wellness.

In contrast, if one or more of the parameters are outside theintersection shape 854, the patient monitor may trigger an alert. Analert may include a change in the display 108, such as a flashingindicator, a change in color or a highlighting of the area of the graphthat is of concern, a text message on or near the graph, an increase inthe size of the current plotted point, a portion of the graph, or thegraph as a whole, a change in the display to the parameter or parameterset causing the alert, or the like. In an embodiment, an alert mayalso—or alternatively—include a tone, ring, buzz, spoken or digitallycreated message, or the like through the audible indicator 114. In anembodiment, alerts can change as a number of measured parameters thatbegin to fall outside the intersection shape 854 increases. Similarly,as measured parameters fall a greater distance from intersection shape854, an alert may change or increase in intensity. The trending datadiscussed above may also affect the severity of alerts. For example, analarm may cease or lessen if trending data indicates a reading isreturning to normal.

As an example, in looking at FIG. 8, when all of the measured parametersfall within intersection shape 854, no alert is triggered. If thecurrent measurement for PI v. PR falls outside intersection shape 854but inside shape 444, while the other measurements remain withinintersection shape 854, a first level alert may be triggered, such as aflashing of that segment of shape 444. If the same PI v. PR measurementcontinues to fall outside shape 444, a second level alert may betriggered, which may include both a visual indication and an audibleindication. If other parameters also begin to fall outside intersectionshape 854, alerts may increase to higher levels, and so on. Thethreshold triggers for each level of alert may differ in variousembodiments, based on, for example, the particular parameters beinggraphically overlaid, and one of skill in the art will understand whichconditions will be of greater concern.

FIG. 9 illustrates an embodiment of the layout of a display 108. In thisembodiment, display 108 illustrates four graphs at the same time indifferent quadrants of the screen. Of course, additional data can bedisplayed in surrounding portions of display 108 in various embodimentsas well. In the first quadrant, a graph 960 illustrates a graph similarto the PI v. PR graph of FIG. 4: shape 444 is outlined and a currentreading of PI v. PR is displayed as point 961. In the second quadrant, agraph 962 illustrates a graph similar to the BP v. PI graph of FIG. 5:shape 548 is outlined and a current reading of BP v. PI is displayed aspoint 963. In the third quadrant, a graph 964 illustrates a graphsimilar to the BP v. PVI graph of FIG. 6: shape 652 is outlined and acurrent reading of BP v. PVI is displayed as point 965. Finally, in thefourth quadrant, graph 966 illustrates the combination of the graphs inthe prior three quadrants with intersection shape 854 and the currentreadings points 961, 963, 965. In the example shown, both points 963 and965 fall outside the intersection area, while point 961 is within it.This condition may trigger an alert to help highlight this state for acaregiver. However, each reading is within the normal bounds for theirassociated shape, so it is also possible that in an embodiment no alertsare triggered.

FIG. 10 is a block diagram illustrating one embodiment of the methods ofindicating a patient's condition described herein. Starting with block1070, a plurality of physiological parameters is measured, such asthrough a pulse oximeter or other patient monitor. A “normal” range isdetermined for the interaction of two of these physiological parameters;this range can be defined as an area of a two-dimensional graph for theintersection of the two selected physiological parameters (block 1072).As described herein, this may be determined from a set of data that wasempirically gathered from a sample of the population. One alternative isto develop this from a period of measurements of the patient beingmonitored, once a number of parameters are measured for a period oftime. In block 1074, a graph is generated of the two physiologicalparameters selected in block 1072. The graph may include arepresentation of the “normal” area and/or a point of intersection forthe most recently gathered patient data. The “normal” area and/orsurrounding areas can be displayed as colored areas, such as green,yellow, and red—in an embodiment—to indicate good to deterioratingconditions. In an embodiment, the graph may also display trending data,such as the most recently measured 3, 5, 10, or the like measurementpoints. Measurements points can be displayed as blinking or colored tohelp provide a more readily identifiable condition.

In block 1076, a choice is made whether to define additional parametersets that are unique from a first pass through blocks 1072-1074. If so,then, as block 1078 indicates, two different physiological parametersare selected and blocks 1072 and 1074 are repeated. This can occurmultiple times as the number of parameters sets that are desiredchanges. Once the desired parameter sets are defined, an intersectionarea consisting of the areas of the “normal” ranges that overlap forvarious parameter sets is defined (block 1080). In an embodiment, one ormore of these parameter set graphs may be normalized to increase ormaximize the intersecting area. In block 1082, the current readings foreach selected parameter set are displayed in relation to theintersection area to provide an overall indication of the patient'scurrent condition. In an embodiment, caregivers can be alerted topossible patient problems when one or more of the graphed points fallsoutside the intersection area (block 1084). For example, if a currentreading of two parameters falls outside the intersection area, a beepingalarm may sound and/or the point may be highlighted to improve the easeof citing the potentially problematic physiological parameter.

Because each individual may have different healthy characteristics, itmay prove advantageous to compare a patient's current status against thepatient's own status when healthy, rather than against a generic notionof an average reading for a healthy individual. For example, it is wellknown that patient's may have very different resting heart rates. Manyathletes, for example, have a resting heart beat that is significantlylower than even a healthy, but less active individual. As such, FIG. 11illustrates an exemplary process for recording baseline patientphysiological parameters that may allow more precise determinations of apatient's status. Starting in block 1190 in the embodiment illustrated,a patient monitoring system 100's sensor 106 is connected to a patientat a monitoring site, at block 1192 the patient is monitored, and atblock 1194 detector 220 signals are accepted by the patient monitor 102(block 1194). It is preferable that the patient undergo this monitoringduring a normal scheduled check-up, or at some other time when thepatient is in good health to provide the best baseline readings. Asillustrated, in an embodiment, the patient monitor 102 may bufferindications of the signals from the sensor 106. These may include thesignals themselves, a digital representation of them, or some otherdatum indicative of the signal (block 1196). In various embodiments,these indications themselves may be stored in a storage device (block1198). As described generally above, storage devices may include a localhard drive, a networked hard drive or server, a flash drive, USB memorystick, or similar, a magnetic or optical disk, such as a CD-ROM orDVD-ROM, and the like. In one embodiment, for example, the sensorsignals may be stored on a USB drive for the patient to keep for theirrecords and stored on a server at the physician's office or uploaded toa server accessible through the Internet or the like. In an embodiment,the patient monitor communicates with such a server through a wired orwireless network connection. In another embodiment, a patient caregivermay manually upload the data to a server. Such a server may beparticularly useful in that the data can then be subsequently retrieved(see discussion of FIG. 12 below) from any of a number of hospitals,urgent care facilities, physician's offices, and the like.

As an alternative, the patient monitor 102 may process the sensorsignals into one or more physiological parameters before storage (blocks11100 and 11102). In general, the signals would be processed intomultiple readings of each physiological parameter over a period of timesuch as, for example, 10 minutes, 30 minutes, or 1 hour. Each suchreading could then be stored in one or more storage devices as describedabove with the “raw” signal data. In yet another embodiment, the patientmonitor 102 may further process the physiological parameters into thegraph areas described herein and store indications of the graph areas.Such an embodiment may allow extended processing during the datagathering phase as illustrated in FIG. 11 and provide minimal dataprocessing in the use of the data at a time when quick patient data maybe critical.

The process generally described in FIG. 11 may be completed on severaldifferent occasions and two or more of the multiple sessions of sensorreadings processed to determine overall physiological parameterstatistics. This may further help account for normal patient conditionfluctuations, changes due to an unknown illness or other medicalcondition, or the like.

As alluded to, FIG. 12 illustrates an embodiment of a process thatutilizes stored data from a process such as that illustrated in FIG. 11.In block 12104, a patient monitor 102 sensor 106 is attached to apatient who has already completed a procedure similar to that describedin FIG. 11. In block 12106, pre-recorded physiological parameterindications are loaded into memory, a cache, a buffer, or the likeassociated with the patient monitor 102. As described above, this datamay comprise anything from raw signals from a sensor 102 to processeddata representing one or more specific physiological parameter grapharea indications. This data is processed (if necessary) (block 12108)for use by the patient monitor 102. Present monitoring of the patientoccurs in block 12110. The patient's current status can then bedisplayed against the one or more graph areas for the physiologicalparameters of interest (block 12112). As described with respect to FIG.10, if the current readings detected by patient monitor 102 and sensor106 fall outside the graph area, an alert can be triggered. Althoughthese methods are illustrated with respect to a specific embodimenthaving a particular order of the blocks, one of ordinary skill wouldunderstand that the arrangement of blocks is an embodiment only, and theblocks may occur in different orders or simultaneously in otherembodiments without departing from the spirit of the disclosure herein.

Although the graphing of wellness indications herein is described interms of a two dimensional graph plane, another embodiment, may combinethree physiological parameters to form a three-dimensional graph. Aplurality of readings of the interaction of the three physiologicalparameters can then define a normal volume that would correspond to thetwo-dimensional cluster shape 444 that is a plane. Similarly to theprocesses described above, multiple normal parameter volumes can beoverlayed to find an intersection volume (corresponding to theintersection area 854). Displays available today are easily capable ofrendering such three dimensional graphics. However, in an embodiment, ahost instrument 223 rendering such graphics may further include inputsthat will allow a caregiver to rotate the display around different axes.With this capability, a caregiver may more easily evaluate a situationand assess which of the different parameters may be causing an alarmstate.

In other embodiments, a patient monitor system 100 automaticallydetermines the patient parameters that can be measured from attachedsensors and devices and determines one or more default graphs togenerate based on those patient parameters. In another embodiment,default graphs, using default parameters, can be assigned to specificcontrol interfaces 112, such as, for example, “hot keys,” buttons, touchscreen segments, combinations of the same, or the like. Additionally,alerts or alarms can include a variety of triggered actions, such as forexample, sending a page to a pager, a text message, call, or voicemailto a phone, sending an email to one or more email addresses,combinations of the same, and/or the like. Alerts can also includeflashing elements of the display 108, such as a graph's one or morepoints 342, shape 444, intersection shape 854. Beeping, tones, voicerecordings or computer-generated voice messages can also be included inalerts. In an embodiment, a display 108 can be altered to display themost relevant graph to indicate out of normal parameters.

Although the foregoing has been described in terms of certain specificembodiments, other embodiments will be apparent to those of ordinaryskill in the art from the disclosure herein. Moreover, the describedembodiments have been presented by way of example only, and are notintended to limit the scope of the disclosure. Indeed, the novel methodsand systems described herein may be embodied in a variety of other formswithout departing from the spirit thereof. Accordingly, othercombinations, omissions, substitutions, and modifications will beapparent to the skilled artisan in view of the disclosure herein. Thus,the present disclosure is not limited by the preferred embodiments, butis defined by reference to the appended claims. The accompanying claimsand their equivalents are intended to cover forms or modifications aswould fall within the scope and spirit of the disclosure.

What is claimed is:
 1. A method for providing an indication of apatient's condition, the steps of the method comprising: noninvasivelymeasuring a plurality of physiological parameters using a lightattenuation by pulsing blood; loading a wellness range for each of twoor more of the plurality of physiological parameters; displaying an areaof a graph defining a normal range for the intersection of the wellnessranges for two of the plurality of physiological parameters; andplotting on the graph a point of intersection between the twophysiological parameters representing a current measurement.
 2. Themethod of claim 1 further comprising the step of providing an indicationthat the graphed point of intersection is outside the defined normalrange area.
 3. The method of claim 2 wherein the graphed point ofintersection is outside the defined normal range area based on one ofthe two physiological parameters.
 4. The method of claim 2 wherein thegraphed point of intersection is outside the defined normal range areabased on the two physiological parameters.
 5. A method for providing anindication of a patient's condition, the steps of the method comprising:measuring a plurality of physiological parameters; defining a first areaof a graph constituting a normal range for the intersection of a firstset of two of the plurality of physiological parameters; graphing afirst point of intersection between the first set of two physiologicalparameters; defining a second area of the graph constituting a normalrange for an intersection of a second set of two of the plurality ofphysiological parameters, wherein the second set includes at least onephysiological parameter distinct from the first set; defining anintersection area of the first area and the second area; graphing asecond point of intersection between the second set of two physiologicalparameters; and providing an indication of a state of wellness of thepatient based on the first point's relation to the intersection area andsecond point's relation to the intersection area.
 6. The method of claim5 further comprising the step of indicating a state of alert when one orboth of the first point and second point fall outside the intersectionarea.
 7. The method of claim 6 wherein the alert comprises an audiblealert.
 8. The method of claim 6 wherein the alert comprises a coloredindicator on the graph.
 9. The method of claim 5 wherein the step ofdefining a second area of the graph includes normalizing the second areato increase the intersection area.
 10. The method of claim 5 wherein thestep of defining a first area of the graph includes using data pointsfrom the two physiological parameters from the first set that weregathered when the patient was known to be well.
 11. The method of claim10 wherein the step of defining a first area of the graph includesgenerating a best fit curve around the data points.
 12. The method ofclaim 11 wherein the step of defining a first area of the graph includesdisregarding one or more of the data points that are outliers.
 13. Themethod of claim 5 wherein the steps of graphing the first point andgraphing the second point comprise displaying the first and secondpoints on the graph.
 14. The method of claim 5 further comprising thestep of making visual representations of the first area, second area,and intersection area on a display.
 15. A method for providing anindividual baseline for a patient's wellness, the steps of the methodcomprising: measuring a plurality of physiological parameters of thepatient over a period of time, using a non-invasive sensor; identifyinga plurality of graph points for the intersection of at least two of thephysiological parameters, each graph point indicative of the at leasttwo physiological parameters measured at approximately the same time;defining an area of a graph constituting a normal range from theplurality of graph points; and storing for later retrieval at least oneof: the plurality of physiological parameter measurements over time; theplurality of graph points; or the area of a graph constituting thenormal range from the plurality of graph points.
 16. The method forproviding an individual baseline for a patient's wellness of claim 15wherein the step of measuring a plurality of physiological parameters isundertaken when the patient is healthy.
 17. The method for providing anindividual baseline for a patient's wellness of claim 15 furthercomprising loading the stored data and comparing the stored data to atleast one new measurement of physiological parameters of the patient.18. The method for providing an individual baseline for a patient'swellness of claim 17 wherein the steps of loading the stored data andcomparing the stored data to at least one new measurement occur when thepatient's status is unknown.